title: Impact of obesity on operative morbidity and clinical outcome in primary epithelial ovarian cancer after optimal primary tumor debulking.
abstract: BACKGROUND
  Obesity is a common and increasing condition in Western countries and seems to be associated with increased carcinogenesis and tumor invasiveness. We evaluated operative and clinical outcome in patients operated to treat primary epithelial ovarian cancer (EOC) according to their body mass index (BMI).
  
  
  METHODS
  All consecutive EOC patients who underwent cytoreductive surgery in our institution between September 2000 and April 2010 were systematically evaluated according to their BMI (kg/m(2)). Survival was calculated by Kaplan-Meier curves. Logistic regression and Cox regression analysis were performed to identify the impact of obesity on surgical outcome and survival.
  
  
  RESULTS
  Three hundred six patients were evaluated. A total of 40.2% were classified as overweight; 87 (28.4%) had a BMI of 25-30 kg/m(2) and 36 (11.8%) had a BMI of ≥30 kg/m(2). No statistically significant differences regarding tumor-related characteristics and comorbidities existed between normal-weight and overweight patients. Median operation time was significantly longer (P = 0.024) in overweight versus normal-weight patients (280 min; range 40-529 vs. 257 min; range 32-592, respectively). Complete tumor resection rates were equivalent between the two patient groups (68.6% vs. 72.5%; P = 0.543) with similar median overall and progression-free survival in both groups (43 vs. 42 months and 21 vs. 17.8 months, respectively). Operative morbidity was also not significantly different between the two groups. By comparable morbidity, operative procedures were similar between normal-weight and overweight patients, apart from higher intestinal and diaphragmatic resection rates in the overweight patients (61% vs. 43.7%; P = 0.004 and 24.4% vs. 14.2%; P = 0.034). In multivariate analysis, BMI of ≥25 kg/m(2) did not reveal any prognostic significance in respect of survival, operative morbidity, and complete tumor resection.
  
  
  CONCLUSIONS
  BMI does not appear to influence tumor stage, histology, differentiation grade, or tumor marker levels in patients with primary EOC. Also, BMI is not an independent predictive and prognostic marker of survival, operative outcome, or morbidity at the time of primary tumor debulking.
authors.affiliation: Department of Gynecology, European Competence Center for Ovarian Cancer, Charité University-Hospital, Berlin, Germany. chfotopoulou@gmail.com
authors.forename: Christina
authors.initials: C
authors.lastname: Fotopoulou
authors.forename: Rolf
authors.initials: R
authors.lastname: Richter
authors.forename: Elena-Ioana
authors.initials: EI
authors.lastname: Braicu
authors.forename: Marc
authors.initials: M
authors.lastname: Kuhberg
authors.forename: Aarne
authors.initials: A
authors.lastname: Feldheiser
authors.forename: Joerg C
authors.initials: JC
authors.lastname: Schefold
authors.forename: Werner
authors.initials: W
authors.lastname: Lichtenegger
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002291:Carcinoma, Papillary / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D018284:Cystadenocarcinoma, Serous / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D009765:Obesity / Q000150:complications*; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult